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Diabetes

Metformin related queries

01/20/2010

Question:

I have browsed several questions responses of which are really full of erudition. You deserve a cmpliments from us for meaningful guidance. I wanted to ask 3 queries :

1. whether Metformin is helpful in weight management / I am hypertensive and obese but not diabetic. I go for a walk, less sugar, less carbohydrates. U guide me the role of metformin in obese patients with Impaired Fasting glucose but who is following up life style modifications with normal lipid, normal thyroid, normal kidney-liver function normal TMT 2D Echo Male 50 years with weight is 111 kg

2. In inpaired glucose tolerance does taking Metformin 500 daily delay the progression of diabetes? I need your guidance because I have a consistent Fasting glucose of 114 to 120 during 2008/09 Yesterday OGTT revealed FBS 114 1st Hour 238 and IInd hour 189

3. whether metformin should be taken before break fast or after meals. What is the ideal way ?

I shall be obliged to receive your guidance

Answer:

There is a clinical trial, the type 2 diabetes prevention program, which demonstrated that metformin slows the progression to type 2 diabetes from a "pre-diabetes" state like impaired fasting glucose.  The blood sugars you mention would fit this category. I believe the dose of metformin used was higher than that and usually we adjust the dose gradually from that which you mentioned in steps to as much as 1000 mg twice daily.  It is not so clear cut whether it will necessarily cause weight loss in all people however.  Some people take metformin without regard to meals but many people find that they tolerate it better taking it after they have already had something to eat.  I generally advise people to start taking it with food and then experiment on their own with whether it matters.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati